Warm & Fuzzy Medicine
The Sensitive Side of Health Care

 First Impressions: Building Med Cred

Doctor Tom Saves the Day!Doctor Tom Saves the Day! by Murray Barnes via Flickr 

We judge

We critique individuals, ideas, and situations based on personality, beauty, intellect, function, relevance, and whether they meet our expectations.

We are optimistic, but…

The good news is that the early attitudes we form by first impressions generally lean to cautiously favorable [1]. However if unfavorable, the bad news is that once formed, first impressions can be resistant to change [2]. Good or bad, first impressions are influential in establishing and maintaining social relations, which affect future interactions, relationship development, and in clinical settings, patient outcomes. Demonstrating the significance of first impressions, let’s look at how they can influence our attitudes and relationships.

We evaluate in milliseconds.

Faces

First impressions form quickly, can be rather difficult to alter once initiated, and influence subsequent interactions. In research exposing participants to facial images for as little as 100 to 500 milliseconds, investigators found that opinions were formed about how likeable, trustworthy, competent, and aggressive those in the photos seemed. Later trials indicated that when permitted longer exposures (i.e., 1,000 ms) to the photos, the participants assessed the images more negatively, in shorter response times, and were more confident about their evaluations. The investigation also revealed that trustworthiness was among the traits appraised most rapidly, suggesting that it is one of the first characteristics that people try to detect during initial encounters with others [3].

Voices

Recently, scientists recorded people reading a paragraph containing the word “hello.” The word was then isolated and extracted from the recordings and participants listened to and rated the voices on a variety of personality traits. The researchers found remarkable agreement among the raters that the voices conveyed or lacked characteristics of trustworthiness, likeability, warmth, aggressiveness, and dominance [4].

The results of these studies correspond with other researchers’ and theorists’ views that judgments of trustworthiness are innate, summoned as instincts for human survival [5], and support beliefs that humans are “especially efficient in making inferences about trustworthiness [3].”  Additional research also suggests that we form first impressions about personality and character based on our perceptions about others’ group memberships (via stereotyping) [2], how they dress [6], and whether their attitude and activity preferences are similar to our own [7].

Shortcuts

The studies described above involved tightly controlled conditions using exceptionally brief visual and voice cues. However, we do not typically assess people based on single, isolated units of communication, but in “packages” containing verbal, nonverbal, situational, and contextual features. We do however, often use shortcuts to make quick assessments about others’ attributes, emotions, and attitudes, which can lead to positive and negative clinical consequences. “Thin-slice vision” is our ability to form conclusions about strangers’ personalities, emotional states, sexuality, biased attitudes, intelligence, power, relationships, and even future outcomes based on watching nonverbal behaviors [8]. We can do this in less than 5 to 30 seconds (thin slices). For example, participants rated occupational therapy students on their emotional expressiveness (i.e., awareness, interest, sociability, personal competence, & self-consciousness) and nonverbal expressiveness (i.e., responsive, friendly, dominant, critical, & polite) by viewing 15-second clips of their preclinical interviews. The evaluations predicted the students’ later clinical performance scores. The students evaluated as positive in emotional and nonverbal expressiveness were rated more effective in physical, pediatric, and psychiatric rehabilitation than those rated negatively expressive [9].

Attitudes toward clinicians can influence patients’ progress in therapy. In another study, participants watched one-minute videotape segments of therapy sessions and rated the physical therapists’ facial expressive (e.g., warm, optimistic, supportive) and nonverbal behaviors (e.g., smiles, frowns, forward leans). The ratings actually predicted the future progress of the patients. Patients treated by physical therapists judged as distant (i.e., not smiling and looking away from patient) experienced decreases in physical, psychological, and cognitive functioning and increases in ratings of confusion. Patients treated by positively-rated therapists (i.e., those who smiled, nodded, frowned) improved their daily living activities such as grooming, bathing, and walking independently, and experienced decreases in levels of confusion. The positive effects lasted three months after being discharged from treatment. The authors suggested that the expressions of nodding and frowning conveyed clinicians’ concerns and empathy for patients, which led to patient satisfaction and physical progress [10].

Relevance

How do your patients initially size you up? Understanding the influences and significance of first impressions, professionals must be mindful that patients form opinions quickly, that their evaluations can be based upon minimal information, and can be enduring. Acknowledging the importance of first impressions, let’s examine the composition of effective clinical salutations, beginning with “Hello!” Next, see GREETINGS.

NPR You Had Me At Hello – The Science Behind First Impressions

References

  1. King, A. R., & Pate, A. N. (2002). Individual differences in judgmental tendencies derived from first impressions. Personality and Individual Differences, 33, 131-145.
  2. Wyer, N. A. (2010). You never get a second chance to make a first (implicit) impression: The role of elaboration in the formation and revision of implicit impressions. Social Cognition, 28, 1-19. doi:10.1521/soco.2010.28.1.1
  3. Willis, J. & Todorov, A. (2006). First impressions: Making up your mind after a 100-ms exposure to a face. Psychological Science, 17, 592-598. doi:10.1111/j.1467-9280.2006.01750.x.
  4. McAleer, P., Todorov, A. , & Belin, P. (2014). How do you say ‘Hello’? Personality impressions from brief novel voices. PloS One, 9 (3): e90779. doi: 10.1371/journal.pone.0090779
  5. Cosmides, L. & Tooby, J. (1992). Cognitive adaptations for social exchange. In J. Barkow, L. Cosmides, & J. Tooby (Eds.), The adapted mind: Evolutionary psychology and the generation of culture (pp. 163-228). London: Oxford University Press.
  6. Temple, L. E., & Loewen, K. R. (1993). Perceptions of power: First impressions of a woman wearing a jacket. Perceptual and Motor Skills, 76, 339-348.
  7. Lydon, J. E., Jamieson, D. W., & Zanna, M. P. (1988). Interpersonal similarity and the social and intellectual dimensions of first impressions. Social Cognition, 6, 269-286.
  8. Weisbuch, M., & Ambady, N. (2011). Thin-slice vision. In R. G. Adams, N. Ambady, K. Nakayama, & S. Shimojo (Eds.), The science of social vision (pp. 228-247). New York, NY: Oxford University Press.
  9. Tickle-Degnen, L., & Puccinelli, N. M. (1999). The nonverbal expression of negative emotions: Peer and supervisor responses to occupational therapy students’ emotional attributes. Occupational Therapy Journal of Research, 19, 1-29.
  10. Ambady, N., Koo, J., Rosenthal, R., & Winograd, C. H. (2002). Physical therapists’ nonverbal communication predicts geriatric patients’ health outcomes. Journal of Personality and Social Psychology, 70, 996-1011.

Bibliography

Roter, D. L., Hall, J. A., Blanch-Hartigan, D., Larson, S., & Frankel, R. M. (2011). Slicing it thin: New methods for brief sampling analysis using RIAS-coded medical dialogue. Patient Education and Counseling, 82, 410-419. doi:10.1016/j.pec.2010.11.019